Walden

Question 1

1st line treatment is Propranolol/Inderal

Answer 1

Tremor

Question 2

give Ambien not Benadryl

Answer 2

Insomnia in elderly

Question 3

1. Heart issues,
2. Cancers (lung, colorectal),
3. Chronic lower respiratory disease

Answer 3

Death - HCC

Question 4

highest mortality, smoking common risk factor, non-small cell carcinoma,
Dx - gold standard lung biopsy, cxray, CBC, refer to pulmonologist low dose CT, stop
screening if smoking stops for 15 years or short life expectancy

Answer 4

Lung cancer

Question 5

risk factors age, IBD, family history, colon polyps, lifestyle risk factors,
Dx - screen at 50 colonoscopy, sigmoidoscopy in 5 years, fecal occult test, CBC, refer to gastro

Answer 5

Colorectal cancer

Question 6

cancer of the bone marrow, bone pain, weakness,
Dx - CBC, FOBT,
Tx - refer to hematologist affects African race

Answer 6

Multiple myeloma

Question 7

lethal cancer 5-year survival rate, most metastases by time of diagnoses, weight loss , anorexia, jaundice weakness, and abdominal pain
Dx - AST ALT bilirubin lipase amylase
Tx - refer to GI surgeon for Whipple procedure

Answer 7

Pancreatic cancer

Question 8

or pencil like stool rule out colon cancer

Answer 8

Ribbon like

Question 9

acute onset of limping, guarding, difficulty bearing weight, new onset of
hip pain referred to knee or groin, unequal leg length, affected led is abducted

Answer 9

Hip fracture

Question 10

opacity in lens, difficulty with glare, halos around light, blurred vision,
gradual onset of decreased night vision, red reflex disappears (Red reflex is now opaque gray instead of orange red glow) COMMON CAUSE OF BLINDNESS DEVELOPING COUNTRIES

Answer 10

Cataracts

Question 11

loss of center vision, loss of visual acuity, contrast sensitivity but still have peripheral vision, may find Drusen bodies,
Dx - Amsler grid to evaluate central vision changes COMMON CAUSE OF BLINDNESS IN UNITED STATES

Answer 11

Macular degeneration

Question 12

sudden onset of shower floaters/specs with looking thru curtain with sudden flashes of light, risk factors extreme nearsightness, cataract surgery, family history,
Tx - laser surgery or cryopexy (freezing) refer to ED, lead to blindness

Answer 12

Retinal detachment

Question 13

an arc or circle around the cornea, common in older adults >50, opaque grayish to white ring at the periphery of the cornea, not associated with visual changes, caused by cholesterol and fat deposit, Dx - check lipid profile

Answer 13

Arcus senilis

Question 14

is affected by age than humoral immunity

Answer 14

Cellular immunity

Question 15

is a state of physical, emotional, and mental exhaustion that may be
accompanied by a change in attitude – from positive and caring to negative and unconcerned, Caregivers who are “burned out” may experience fatigue, stress, anxiety, and depression anxiety, depression, irritability, feeling tired and run down, Difficulty sleeping, Overreacting to minor nuisances, New or worsening health problems.

Answer 15

Caregiver burnout

Question 16

Chronic form, before loss of peripheral visual fields, its asymptomatic, excellent prognosis if TX early

Answer 16

Open angle glaucoma

Question 17

ill appearing, sudden decrease visual acuity, eyes reddened, profuse tearing, acute onset of eye pain, acute visual loss, severe headache, N/V, may lead to blindness, halos around lights, cloudy cornea,
Tx - refer to ED tonometry in ED to measure IOP

Answer 17

Angle closure glaucoma

Question 18

caused by obstruction of the outflow channels, especially the meshwork (affected by aging), or overproduction of the aqueous humor. Ocular trauma, inflammation of the uveitis, chronic steroid use, vasoproliferative retinopathy, and recurrent retinal hemorrhages, KNOW WHAT PART OF THE EYE CAN BE SEEN ON OPTHOMOLOGIC EXAM THAT WILL SHOW IOP

Answer 18

IOP intraocular pressure

Question 19

temporal headache one side with tenderness or induration over temporal artery, sudden visual loss in one eye, scalp tenderness on affected side
Dx - elevated sedimentation rate, CRP, refer to ER

Answer 19

Temporal arthreitis

Question 20

sudden onset of neuro dysfunction worsens within hours, brain attack, blurred vision, slurred speech, one sided weakness, hemianopsia, confusion, symptoms dependent on side of infarct, TIA is temporary episode lasting less than 24 hours

Answer 20

CVA

Question 21

underlying illness involving marked weight loss and muscle loss.

Answer 21

Cachexia

Question 22

loss of muscle mass related to aging

Answer 22

Sarcopenia

Question 23

systolic blood pressure drops 20 mmHg or more within 3 minutes moving to a more upright position

Answer 23

Orthostatic hypotension

Question 24

NSAID increases risk of GI bleed or ulceration

Answer 24

Celecoxib

Question 25

a person who is from 80 to 89 years old.

Answer 25

Octogenarian

Question 26

sty

Answer 26

Hordeolum

Question 27

high pitch hearing loss from aging, generally sensorineural not conductive

Answer 27

Presbycusis

Question 28

loss involves external canal and middle ear preventing sound from traveling beyond the middle ear

Answer 28

Conductive hearing

Question 29

reduces prostate size

Answer 29

5 alpha reductase inhibitors

Question 30

not normal sign of aging, | Tx - lifestyle modifications, dietary, Kegel absorbent pads, refer to urologist

Answer 30

Urinary incontinence

Question 31

pressure form laughing, sneezing coughing, | Tx - Kegel exercise decongestants

Answer 31

Stress incontinence

Question 32

sudden strong urge to void immediately, overactive bladder TX anticholinergics/oxybutynin, impamine/tricyclic/antidepressant

Answer 32

Urge incontinence

Question 33

frequent dribbling from full bladder, due to blockage BPH, | Dx - BPH

Answer 33

Overflow incontinence

Question 34

problems with mobility, pulling pants down | Tx - physical therapy bedside commode

Answer 34

Functional in incontinence

Question 35

stress and urge incontinence

Answer 35

Mixed incontinence

Question 36

herniation of bladder TX refer for pessary placement

Answer 36

Cystocele

Question 37

rectum TX Kegel, avoid straining, pessary placement

Answer 37

Rectocele

Question 38

cervix, TX avoid straining, pessary placement, surgical repair by urologist

Answer 38

Uterine prolapse

Question 39

TX education and behavior modification, dietary changes, bulk forming fibers, physical activity, fluid intake, laxative treatment, bowel retraining program

Answer 39

Chronic constipation

Question 40

irreversible brain disorder involves loss of learned cognitive and physical/motor skills, common cause is 1. Alzheimer, 2nd vascular

Answer 40

Dementia

Question 41

brain image MRI, thorough history of patients changed behavior, memory, function, personality form family, cognitive testing performance scales (flostein mini-mental exam MMSE, min- cog, ACE-R, Beck depression, ADL self-performance, Index of social engagement)

Answer 41

Dementia Dx

Question 42

Thorough health, drug, medical history, family interview, refer to neurologist, MRI of brain preferred image testing

Answer 42

Dementia Tx

Question 43

accumulation of neurofibrillary plaques/tangles cause permanent damage to brain life expectancy 65 years old, diagnosed 4- 8 years, 3 A’s Aphasia- difficulty verbalizing, Apraxia- difficulty walking, Agnosia- inability to recognize familiar people or objects

Answer 43

Alzheimer

Question 44

Cholinesterase inhibitors – Aricept/donepezil, galantamine/razadyne, rivastigmine/Exelon, memantine/Namenda, ginko bilba, refer to neuro

Answer 44

Alzheimer Tx

Question 45

- Lewy bodies often have memory loss and thinking problems common in Alzheimer’s - initial or early symptoms such as sleep disturbances, well-formed visual hallucinations, and slowness, gait imbalance or other parkinsonian movement features.

Answer 45

Dementia with Lewy bodies

Question 46

Previously known as multi-infarct or post-stroke dementia, vascular dementia is less common as a sole cause of dementia than Alzheimer’s, accounting for about 10 percent of dementia cases.

Answer 46

Vascular dementia

Question 47

Symptoms: Impaired judgment or ability to make decisions, plan or organize is more likely to be the initial symptom, as opposed to the memory loss often associated with the initial symptoms of Alzheimer's. Occurs from blood vessel blockage or damage leading to infarcts (strokes) or bleeding in the brain.

Answer 47

Vascular dementia s/s

Question 48

Most common type of dementia; accounts for an estimated 60 to 80 percent of cases. Symptoms:

Answer 48

Alzheimer's disease

Question 49

Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired communication, poor judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking.

Answer 49

Alzheimer's S/S

Question 50

Includes dementias such as behavioral variant, corticobasal degeneration and progressive supranuclear palsy. Symptoms: Typical symptoms include changes in personality and behavior and difficulty with language. Nerve cells in the front and side regions of the brain are especially affected.

Answer 50

Frontotemporal dementia | Pick's Disease

Question 51

Acute confusional state, reversible temporary process, duration hours to days, acute and dramatic onset, excitable irritable combative short attention span, memory loss disorientation, fever, shock, dehydration, substance abuse, drug to drug interaction, infection, electrolyte imbalance, Tx - treat illness, infection and delirium will resolve

Answer 51

Delirium

Question 52

occurs in both delirium and dementia patient becomes agitated, confused, combative, resolves in morning Tx - avoid quiet and dark rooms, well- lit rooms avoid drugs that affect cognition

Answer 52

Sun downing phenomenon

Question 53

progressive neurogenerative disease depression is common, Dx - 3 symptoms tremor, muscular rigidity, bradykinesia, gradual onset of pill rolling, shuffling gait, poor balance, mood disorders, daytime sleepiness, worsening sebhorric dermatitis, Tx - bradykinesia tremors, Carbidopa/levodopa, physical therapy speech therapy, deep brain stimulation, refer to neuro

Answer 53

Parkinson’s disease

Question 54

action or postural tremor not resting tremor, not curable but can be controlled with medication TX propranolol, Mysoline refer to neurologist

Answer 54

Essential tremor

Question 55

loss sense of smell

Answer 55

Anosmia

Question 56

form of aphasia, unable to recall names of everyday objects

Answer 56

Anomia

Question 57

difficulty verbalizing

Answer 57

Aphasia

Question 58

difficulty to remember learned motor skill

Answer 58

Apraxia

Question 59

difficulty cording voluntary movement

Answer 59

Ataxia

Question 60

inability recognize object placed in palm

Answer 60

Astereognosis

Question 61

inability to recognize familiar people or objects

Answer 61

Agnosia

Question 62

memory loss

Answer 62

Amnesia

Question 63

reduced voluntary muscle

Answer 63

Akinesia

Question 64

intense need to move, restlessness

Answer 64

Akathisia

Question 65

loss of motivation or desire to do tasks, urinates in public

Answer 65

Abulia

Question 66

ability to speak but not comprehend

Answer 66

Brocas aphasia

Question 67

lying due to not remembering event

Answer 67

Cofabulation

Question 68

abnormal involuntary muscle rigidity

Answer 68

Dyskinesia

Question 69

nvoluntary repetitive muscle movements muscle spasms

Answer 69

Dystonia

Question 70

when asked to interpret a proverb

Answer 70

Abstract thinking

Question 71

popular screening for dementia and Alzheimer’s

Answer 71

Flostein mini-mental exam MMSE